Osteoinductive bone material

ABSTRACT

Osteogenic bone implant compositions that approximate the chemical composition of natural bone are provided. The organic component of these implant compositions is osteoinductive despite the presence of the inorganic component and, further, is present in an amount sufficient to maximize the regenerative capabilities of the implant without compromising its formability and mechanical strength. The composition may be an osteoinductive powder, including demineralized bone matrix (DBM) particles, a calcium phosphate powder, and, optionally, a biocompatible cohesiveness agent. The powder may be combined with a physiologically-acceptable fluid to produce a formable, osteoinductive paste that self-hardens to form a poorly crystalline apatitic (PCA) calcium phosphate having significant compressive strength. The bone implant materials retain their cohesiveness when introduced at an implant site and are remodeled into bone in vivo. Methods for using these implant materials to repair damaged bone and a method of assaying the content of DBM particles, by weight, in a bone implant material are also provided.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of the filing date of U.S.Provisional Application No. 60/462,416, filed on Apr. 11, 2003, which isincorporated herein by reference.

BACKGROUND OF THE INVENTION

The field of the present invention is bone repair and replacement. Morespecifically, the invention relates to a self-hardening, osteogeniccomposition, which has desirable handling characteristics and mechanicalproperties.

Naturally-occurring bone is comprised of both organic and inorganiccomponents. The organic component includes growth factors, cartilage,collagen, and other proteins. The inorganic bone component includesnon-stoichiometric, poorly crystalline apatitic (PCA) calcium phosphate,having a Ca/P ratio between 1.45 and 1.75 (Besic et al. (1969) J. DentalRes. 48 (1): 131). This inorganic bone mineral is continuously resorbedand regenerated in vivo by osteoclasts and osteoblasts.

Bone implants are often used to augment the natural regeneration processin the event of bone defects and injuries. These implants must bebiocompatible. Additionally, an ideal bone implant should be osteogenic,i.e., both osteoconductive and osteoinductive, easily manipulated by asurgeon prior to implantation, and of a strength and composition suchthat the implant will maintain its shape in vivo.

Given its regenerative capabilities, natural bone is a potential implantmaterial. However, the use of autogenic, allogenic, and xenogeneic boneis complicated by associated disease transmission, immunogenic implantrejection, patient morbidity, and complicated surgical procedures. Thus,synthetic bone implant materials have become the focus of increasingattention.

Metal implant devices have been and continue to be used because of theirhigh strength and stability. Despite these advantages, metal devices aredisfavored because they cannot be resorbed into natural bone mineral andare, consequently, permanent foreign bodies once implanted.

To overcome the deficiencies of metal implants, compositions moreclosely approximating natural bone have been developed. Organic,osteoinductive materials are desirable components of such compositions.Commonly used osteoinductive materials include demineralized bone matrix(DBM) and recombinant human bone morphogenic proteins (rh-BMPs; see,e.g., U.S. Pat. No. 6,030,635; European Patent Appln. No. 0 419 275;PCT/US00/03024; PCT/US99/01677; and PCT/US98/04904). These organic,osteoinductive materials are typically delivered to in implant site incombination with a fluid or gelatinous carrier (see, e.g., U.S. Pat. No.6,030,635; U.S. Pat. No. 5,290,558; U.S. Pat. No. 5,073,373; andPCT/US98/04904). An ideal bone implant includes substantial quantitiesof these osteoinductive materials so as to maximize its regenerativecapabilities.

These organic, osteoinductive materials have previously been combinedwith hydroxyapatite and/or tricalcium phosphate to form synthetic bonecompositions. The utility of these synthetic bone implants is offset bythe tendency of the hydroxyapatite and/or tricalcium phosphate toinhibit the osteoinductivity of the organic component (see, e.g.,Redondo, L. M. et al. (1995) Int. J. Oral Maxillofac. Surg. 24(6):445-448; Lindholm, T. C. et al. (1993) Ann. Chir. Gynaecol. Suppl.207:91-98; Alper, G. et al. (1989) Am. J. Med. Sci. 298 (6):371-376).More recently, organic, osteoinductive materials have been combined withresorbable calcium phosphate compositions, such as those includingamorphous calcium phosphate and poorly crystalline apatitic (PCA)calcium phosphate (see, e.g., U.S. Pat. No. 6,027,742; PCT/US00/20630;and PCT/US00/03024). The mechanical strength of these implants, though,diminishes as larger quantities of the osteoinductive component (e.g.,DBM) are incorporated. Furthermore, implants containing desirableamounts of osteoinductive materials tend to be difficult to manipulateand to lose their cohesiveness and shape in vivo. Therefore, there is aneed for improved bone implant materials containing a calcium phosphatecomponent and DBM particles that have a high compressive strength.

SUMMARY OF THE INVENTION

Osteogenic bone implant compositions are provided that approximate thechemical composition of natural bone. The organic component of theseimplant compositions is osteoinductive despite the presence of theinorganic component and, further, is present in an amount sufficient tomaximize the implant's regenerative capabilities without compromisingits formability and mechanical strength.

In one aspect, the composition is an osteoinductive powder includingdemineralized bone matrix (DBM) particles, a calcium phosphate powder,and, optionally, a biocompatible cohesiveness agent (e.g., a binder).The DBM particles may be of various sizes and shapes. In a preferredembodiment, the calcium phosphate powder includes an amorphous calciumphosphate and a second calcium phosphate source. In some embodiments,the amorphous calcium phosphate and the second calcium phosphate sourcehave an average crystalline domain size of less than 100 nm. Suchcrystalline domain sizes may be obtained by, for example, high energymilling processes. In some embodiments, the second calcium phosphatesource is an acidic calcium phosphate. In other embodiments, theosteogenic powder, upon hydration with a physiologically acceptablefluid, self-hardens to form a poorly-crystalline apatitic calciumphosphate. In yet other embodiments, the poorly-crystalline apatiticcalcium phosphate has a Ca/P ratio of less than 1.67. A particularlypreferred osteogenic powder includes demineralized bone matrix (DBM)particles, a combination of calcium phosphate powders, and, optionally,a biocompatible cohesiveness agent (e.g., a binder), in which thecombination of calcium phosphate powders react, when admixed with aphysiologically acceptable liquid, to for an apatitic calcium phosphatehaving an overall Ca/P ratio in the range of about 1.0 to about 1.67,preferably 1.3-1.65, more preferably 1.4-1.6, and most preferably closeto that of naturally-occurring bone, that is in the range of 1.45 to1.67. In other embodiments of the osteoinductive powder, the DBMparticles are present in an amount of less than about 60 wt %, less thanabout 50 wt %, less than about 20 wt % (e.g., about 15 wt %), or the DBMparticles are present in an amount in the range of about 1 to about 60wt %. In yet other embodiments, the DBM particles have a particle sizeof less than about 850 μm (e.g., less than about 125 μm), for example,in the range of about 125 to about 850 μm or in the range of about 53 toabout 125 μm.

In another aspect, the composition is a formable, self-hardening, poorlycrystalline apatitic (PCA) calcium phosphate paste including anosteoconductive powder as described above and aphysiologically-acceptable fluid. The paste is cohesive when applied toan implant site in vivo. In at least some embodiments, the paste hardensto form a poorly crystalline apatitic (PCA) calcium phosphate havingsignificant strength. The composition may be implanted in vivo in pasteform or as hardened PCA calcium phosphates to repair damaged bone. Inother embodiments, the formable, self-hardening, osteoinductive pastehardens to form a poorly-crystalline apatitic calcium phosphate. In yetother embodiments, the poorly-crystalline apatitic calcium phosphate hasa Ca/P ratio of less than 1.67. In particularly preferred embodiments,the formable, self-hardening, osteoinductive paste hardens to form anapatitic calcium phosphate having an overall Ca/P ratio in the range of1.0-1.67, preferably 1.3-1.65, more preferably 1.4-1.6, and mostpreferably close to that of naturally-occurring bone, that is in therange of 1.45 to 1.67. In a preferred embodiment, the poorly-crystallineapatitic calcium phosphate has a Ca/P ratio of equal to or less thanabout 1.5.

In preferred embodiments, the formable, self-hardening, PCA calciumphosphate paste additionally includes a cohesiveness agent. Preferredcohesiveness agents include polymers selected from polysaccharides,nucleic acids, carbohydrates, proteins, polypeptides, poly(α-hydroxyacids), poly(lactones), poly(amino acids), poly(anhydrides),poly(orthoesters), poly(anhydride-co-imides), poly(orthocarbonates),poly(α-hydroxy alkanoates), poly(dioxanones), poly(phosphoesters),poly(L-lactide) (PLLA), poly(D,L-lactide) (PDLLA), polyglycolide (PGA),poly(lactide-co-glycolide (PLGA), poly(L-lactide-co-D, L-lactide),poly(D,L-lactide-co-trimethylene carbonate), polyhydroxybutyrate (PHB),poly(ε-caprolactone), poly(δ-valerolactone), poly(γ-butyrolactone),poly(caprolactone), polyacrylic acid, polycarboxylic acid,poly(allylamine hydrochloride), poly(diallyldimethylammonium chloride),poly(ethyleneimine), polypropylene fumarate, polyvinyl alcohol,polyvinylpyrrolidone, polyethylene, polymethylmethacrylate, carbonfibers, poly(ethylene glycol), poly(ethylene oxide), poly(vinylalcohol), poly(vinylpyrrolidone), poly(ethyloxazoline), poly(ethyleneoxide)-co-poly(propylene oxide) block copolymers, poly(ethyleneterephthalate)polyamide, and copolymers thereof. Preferred cohesivenessagents also include alginic acid, arabic gum, guar gum, xantham gum,gelatin, chitin, chitosan, chitosan acetate, chitosan lactate,chondroitin sulfate, N,O-carboxymethyl chitosan, a dextran (e.g.,α-cyclodextrin, β-cyclodextrin, γ-cyclodextrin, or sodium dextransulfate), fibrin glue, glycerol, hyaluronic acid, sodium hyaluronate, acellulose (e.g., methylcellulose, carboxy methylcellulose, hydroxypropylmethylcellulose, or hydroxyethyl cellulose), a glucosamine, aproteoglycan, a starch (e.g., hydroxyethyl starch or starch soluble),lactic acid, a pluronic, sodium glycerophosphate, collagen, glycogen, akeratin, silk, and mixtures thereof.

According to some embodiments, the composition additionally includes abiologically active agent. Biologically active agents that can be usedin the compositions and methods described herein include, withoutlimitation, an antibody, an antibiotic, a polynucleotide, a polypeptide,a protein (e.g., an osteogenic protein), an anti-cancer agent, a growthfactor, and a vaccine. Osteogenic proteins include, without limitation,BMP-2, BMP-4, BMP-5, BMP-6, BMP-7, BMP-10, BMP-12, BMP-13, and BMP-14.Anti-cancer agents include, without limitation, alkylating agents,platinum agents, antimetabolites, topoisomerase inhibitors, antitumorantibiotics, antimitotic agents, aromatase inhibitors, thymidylatesynthase inhibitors, DNA antagonists, farnesyltransferase inhibitors,pump inhibitors, histone acetyltransferase inhibitors, metalloproteinaseinhibitors, ribonucleoside reductase inhibitors, TNF alpha agonists, TNFalpha antagonists, endothelin A receptor antagonists, retinoic acidreceptor agonists, immuno-modulators, hormonal agents, antihormonalagents, photodynamic agents, and tyrosine kinase inhibitors.

The composition may optionally include an effervescent agent. Anexemplary effervescent agent is sodium bicarbonate, carbon dioxide, air,nitrogen, helium, oxygen, and argon. The composition may include, forexample, from about 1 to about 40 weight percent of an effervescentagent.

In yet another aspect, a method of assaying the amount of DBM, byweight, in a mixture including DBM and a calcium phosphate powder isprovided.

We have observed that small size DBM particles of 53-125 μm (i.e.,Fines) and full range DBM particles (e.g., of 125-850 μm) demonstratesignificant bone induction when implanted without a carrier. We alsoobserved that DBM fines tested in an ectopic (athymic rat) model inducedmore bone formation than did the full range DBM particles, while DBMfines tested without a carrier in a sheep interbody fusion modeldemonstrated 100% fusion rates. Commercial DBM suppliers and tissuebanks supply DBM within the 125-180 μm range as a bone graft extender orreplacement for orthopedic applications. DBM in the 53-125 μm range isnot used for orthopedic applications. We believe that the use of 53-125μm DBM is a novel approach to utilizing DBM for orthopedic applications.

As used herein, the term “about” means±10% of the recited value.

As used herein and applied to a calcium phosphate, the term “amorphous”means a calcium phosphate having no or only short range crystallographicorder, i.e., crystallographic order over less than 100 mm.

As used herein and applied to a DBM particle, the term “aspect ratio”means the ratio of the longest dimension of the particle to the shortestdimension of the particle.

As used herein, a “biocompatible” substance is one that is non-toxic anddoes not provoke an undesirable physiological response, e.g., an immuneresponse, in the recipient.

As used herein and applied to a composition, the term “cohesiveness”means the ability of the composition, when mixed with a biocompatiblefluid, to maintain its shape without loss of mass. A composition isdeemed cohesive if greater than 90% of its initial mass and volume areretained within its initial shape dimension in an aqueous environmentfor at least 10 minutes.

As used herein, a “cohesiveness agent” means an additive that, whenincluded in a calcium phosphate composition of the invention, improvesthe ability of the calcium phosphate composition to maintain itscohesiveness. Preferred cohesiveness agents include polymers selectedfrom polysaccharides, nucleic acids, carbohydrates, proteins,polypeptides, poly(α-hydroxy acids), poly(lactones), poly(amino acids),poly(anhydrides), poly(orthoesters), poly(anhydride-co-imides),poly(orthocarbonates), poly(α-hydroxy alkanoates), poly(dioxanones),poly(phosphoesters), poly(L-lactide) (PLLA), poly(D,L-lactide) (PDLLA),polyglycolide (PGA), poly(lactide-co-glycolide (PLGA),poly(L-lactide-co-D, L-lactide), poly(D,L-lactide-co-trimethylenecarbonate), polyhydroxybutyrate (PHB), poly(ε-caprolactone),poly(δ-valerolactone), poly(γ-butyrolactone), poly(caprolactone),polyacrylic acid, polycarboxylic acid, poly(allylamine hydrochloride),poly(diallyldimethylammonium chloride), poly(ethyleneimine),polypropylene fumarate, polyvinyl alcohol, polyvinylpyrrolidone,polyethylene, polymethylmethacrylate, carbon fibers, poly(ethyleneglycol), poly(ethylene oxide), poly(vinyl alcohol),poly(vinylpyrrolidone), poly(ethyloxazoline), poly(ethyleneoxide)-co-poly(propylene oxide) block copolymers, poly(ethyleneterephthalate)polyamide, and copolymers thereof. Preferred cohesivenessagents also include alginic acid, arabic gum, guar gum, xantham gum,gelatin, chitin, chitosan, chitosan acetate, chitosan lactate,chondroitin sulfate, N,O-carboxymethyl chitosan, a dextran (e.g.,α-cyclodextrin, α-cyclodextrin, γ-cyclodextrin, or sodium dextransulfate), fibrin glue, glycerol, hyaluronic acid, sodium hyaluronate, acellulose (e.g., methylcellulose, carboxy methylcellulose, hydroxypropylmethylcellulose, or hydroxyethyl cellulose), a glucosamine, aproteoglycan, a starch (e.g., hydroxyethyl starch or starch soluble),lactic acid, a pluronic, sodium glycerophosphate, collagen, glycogen, akeratin, silk, and mixtures thereof.

As used herein, “poorly crystalline apatitic (PCA) calcium phosphate”means a synthetic calcium phosphate material having small crystallinedomains, on the order of those found in naturally-occurring bone, andcharacterized by a broad, poorly-defined X-ray diffraction pattern and aCa/P ratio of less than 1.67. The PCA calcium phosphate is notnecessarily restricted to a single calcium phosphate phase, provided itdemonstrates the characteristic X-ray diffraction pattern of an apatiticmineral, namely two broad peaks in the region of 20-35° with a peakcentered at 26° and a second peak centered at 32°.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is described with reference to the following figures,which are presented for the purpose of illustration only and which arenot intended to be limiting of the invention.

FIG. 1 illustrates the X-ray diffraction (XRD) pattern of a calciumphosphate powder comprising amorphous calcium phosphate and dicalciumphosphate dihydrate (DCPD) before high energy milling and after highenergy milling for 3, 10, 15, and 24 hours in a high energy ball mill.

DETAILED DESCRIPTION OF THE INVENTION

Formable, self-hardening, osteogenic bone implant materials having achemical composition comparable to that of natural bone, and whichretain cohesiveness when introduced at an implant site in vivo, areprovided. These bone implant materials are highly osteoinductive despitetheir chemical composition. Further, upon hardening, these implantmaterials display significant compressive strength.

The bone implant material includes demineralized bone matrix (DBM)particles. The DBM particles are mixed with a calcium phosphate powder,which includes an amorphous calcium phosphate and a second calciumphosphate source to form an osteoinductive powder. The osteoinductivepowder may further include a biocompatible cohesiveness agent (e.g., abinder). Upon combination with a physiologically-acceptable fluid, theosteoinductive powder produces a formable paste that hardens and reactsto form a poorly-crystalline apatitic calcium phosphate. Preferably thepoorly-crystalline apatitic calcium phosphate has a Ca/P ratio of lessthan 1.67. For example, the poorly-crystalline apatitic calciumphosphate desirably has an overall Ca/P ratio in the range of 1.0-1.67,preferably 1.3-1.65, more preferably 1.4-1.6, and most preferably in therange of 1.45 to 1.67 (i.e., close to that of naturally-occurring bone).Preferably, the poorly-crystalline apatitic calcium phosphate has a Ca/Pratio of about 1.5. This PCA calcium phosphate is remodeled into bone invivo. The nature of the calcium phosphate powder and/or the presence ofthe biocompatible cohesiveness agent permit the inclusion of substantialquantities of DBM particles in the bone implant materials withoutcompromising their formability or mechanical strength. Thus, the implantmaterial retains its cohesiveness following implantation at an implantsite in vivo and displays significant compressive strength uponhardening. Notably, in at least some embodiments, the implant materialis highly osteoinductive despite the presence of the inorganic calciumphosphate sources.

DBM is an organic, osteoinductive material most commonly obtained fromlong bone chips demineralized by acid treatment. The acid treatmentdissolves inorganic mineral components and acid-soluble proteins in thebone, leaving behind a collagen matrix as well as acid-insolubleproteins and growth factors (see, e.g., Glowacki et al. (1985) Clin.Plast. Surg. 12 (2):233-241; Covey et al. (1989) Orthop. Rev. 17(8):857-863). Among the residual acid-insoluble proteins and growthfactors are osteoinductive factors, such as bone morphogenic proteins(BMPs) and transforming growth factors (TGFs). Thus, DBM isosteoinductive, fully resorbable, and, when used in combination with thecalcium phosphate powders described herein, yields bone implantmaterials that are highly biocompatible because they closely mimic thechemical composition of natural bone. Advantageously, DBM costs lessthan many other available organic bone composition additives, such asisolated BMPs.

The DBM employed in the bone implant materials is preferably derivedfrom autogenic or allogenic sources. As discussed above, DBM may beobtained by acid treatment of long bone chips, a process well known tothose of ordinary skill in the art. Alternatively,commercially-available DBM may be used (e.g., DBM available fromAllosource, American Red Cross, Musculoskeletal Transplant Foundation,Regeneration Technologies, Inc., and Osteotech, Inc.).

In at least some embodiments, the DBM in the bone implant materials ispresent in an amount between about 10 and about 70 weight percent of thepowder component. In particular embodiments, the DBM is present in anamount equal to about 60 weight percent of the powder component. Inother embodiments, the DBM is present in an amount between about 1 andabout 50 weight percent of the powder component. In still otherembodiments, the DBM is present in an amount less than or equal to about20 weight percent of the powder component. Preferably, the DBM ispresent in an amount less than or equal to about 15 weight percent ofthe powder component.

The amount of DBM in a given composition will vary depending upon thepresence or absence of a biocompatible cohesiveness agent, as well asthe intended use and desired characteristics of the bone implantmaterial. In particular embodiments, the cohesiveness agent is presentin the osteogenic powder in an amount in the range of about 0.5 andabout 20 weight percent of the powder component. In preferredembodiments, the cohesiveness agent is present in an amount of about 5weight percent or less.

Those of skill in the art will be able to determine the amount of DBM,calcium phosphate, and cohesiveness agent required for particularapplications. For example, a preferred osteogenic powder compositionincludes about 15 weight percent DBM and about 85 weight percent calciumphosphate powder. Another preferred osetogenic powder includes about 50weight percent DBM, about 45 weight percent calcium phosphate powder,and about 5 weight percent biocompatible cohesiveness agent.

The DBM particles may be of various sizes and physical forms. As withthe amount of DBM, the size and form of the DBM particles will varydepending upon the intended use of the bone implant material. In someembodiments, the DBM particles have a longest dimension measuringbetween about 35 μm and about 850 μm and may further have an aspectratio of less than about 5. In other embodiments, the DBM particles arefibrous in nature. In some embodiments, these DBM fibers have a lengthbetween about 50 μm and about 3 mm. In other embodiments, these DBMfibers have a length between about 250 μm and about 2 mm. In someembodiments, the aspect ratio of these DBM fibers is greater than 4. Inother embodiments, the aspect ratio of these DBM fibers is greater than10. The DBM fibers may be needle-like, having an average width toaverage thickness ratio of less than 5. Methods of producing DBMparticles of varying sizes will be well-known to those of skill in theart and are disclosed, for example, in co-pending U.S. patentapplication Ser. No. 10/298,112, filed on Nov. 15, 2002, and entitled“Cohesive Demineralized Bone Compositions,” which is incorporated hereinby reference. Of note, the needle-like, fibrous DBM obtained from longbone chips or shavings, as opposed to DBM obtained from ground bone,provide increased cohesiveness when incorporated into the bone implantcompositions of the present invention.

The incorporation of DBM into calcium phosphate-based bone implantmaterials has heretofore been limited, due to the tendency of DBM toreduce the mechanical strength of the implant materials into which it isincorporated. Thus, implant materials containing quantities of DBMnecessary to maximize its osteoinductive capabilities are difficult tomanipulate, lack formability, and lose their cohesiveness and shapefollowing implantation in vivo. The hardened calcium phosphate productis also much weaker. Moreover, the effective use of DBM in bone implantmaterials containing inorganic, osteoconductive components, such ascalcium phosphates, has been heretofore unsuccessful because theinorganic components inhibit the osteoinductivity of the DBM.

The bone implant materials described herein overcome these knowndeficiencies in several ways. According to some embodiments, the boneimplant materials include a calcium phosphate powder having featuresthat increase the mechanical strength of the implant. The calciumphosphate powder includes an amorphous calcium phosphate and a secondcalcium phosphate. Both the amorphous calcium phosphate and the secondcalcium phosphate have an average crystalline domain size of less thanabout 100 nm. This calcium phosphate powder, particularly when combinedwith a physiologically-acceptable fluid to form a self-hardening paste,provides formability and cohesiveness to implant materials containingsubstantial quantities of DBM. Moreover, the calcium phosphate powderdoes not inhibit the osteoinductivity of the DBM; in fact, certainformulations of the implant materials disclosed herein demonstratesuperior osteoinductivity as compared to DBM alone. These advantages arelargely attributable to the crystallinity, particle size, and reactivityof the calcium phosphate sources used to prepare the calcium phosphatepowder. The selection of appropriate amounts, sizes, and shapes of DBMparticles, as discussed herein, also contributes to these advantageouscharacteristics.

As mentioned above, the calcium phosphate powder includes an amorphouscalcium phosphate and a second calcium phosphate source. Amorphouscalcium phosphate has a broad, diffuse X-ray diffraction pattern, ishomogenous when measured on an Angstrom scale, and is a gel-likematerial formed by rapid precipitation from a solution containingcalcium and phosphate ion sources. The rapid precipitation createsnumerous defects in the calcium phosphate nuclei. Under physiologicalconditions, amorphous calcium phosphate has a high solubility, highformation rate, and high rate of conversion to PCA calcium phosphate.

Amorphous calcium phosphate has a Ca/P molar ratio in the range of about1.1 to about 1.9. In at least some embodiments of the instant invention,the amorphous calcium phosphate has a Ca/P molar ratio of less than 1.5.In particular embodiments, the Ca/P molar ratio is between about 1.35and about 1.49. The Ca/P molar ratio of the amorphous calcium phosphatemay be modified by the introduction of additional ions into the calciumand phosphate ion-containing solution. Non-limiting examples of suchadditional ions include CO₃ ²⁻, Mg²⁺, P₂O₇ ⁴⁻, nitrate, nitrite, oracetate ions. The preparation and characterization of amorphous calciumphosphates are described further in U.S. Pat. Nos. 5,650,176 and6,214,368, which are incorporated herein by reference.

In at least some embodiments, the amorphous calcium phosphate is presentin an amount greater than or equal to about 20 wt % of the powdercomponent. In particular embodiments, the amorphous calcium phosphate ispresent in an amount greater than or equal to about 30 wt % of thepowder component.

A second calcium phosphate source is included in the calcium phosphatepowder. The second calcium phosphate source may be crystalline oramorphous. Appropriate second calcium phosphate sources for use in theinstant invention include acidic and neutral calcium phosphates having astoichiometry such that they produce apatitic calcium phosphates uponreaction with amorphous calcium phosphate. Non-limiting examples ofsuitable acidic calcium phosphates include calcium metaphosphate,dicalcium phosphate dihydrate, heptacalcium phosphate, tricalciumphosphate, calcium pyrophosphate dihydrate, poorly crystallinehydroxyapatite, calcium pyrophosphate, and octacalcium phosphate. Inparticular embodiments, the second calcium phosphate source is dicalciumphosphate dihydrate (DCPD).

The amorphous calcium phosphate and the second calcium phosphate sourceshould be selected such that they produce a calcium phosphate powderhaving a desired overall Ca/P molar ratio. Thus, the amorphous calciumphosphate and the second calcium phosphate source are used inproportions ranging from 1:10 to 10:1, or 1:5 to 5:1, or about 1:1. Inat least some embodiments, the desired calcium phosphate product ispoorly crystalline apatitic (PCA) calcium phosphate. Because thereaction forming PCA calcium phosphate from the amorphous calciumphosphate and the second calcium phosphate source proceeds substantiallyto completion, the Ca/P molar ratio of the amorphous calcium phosphateand the second calcium phosphate source should be equivalent to that ofthe product. PCA calcium phosphate has a Ca/P molar ratio between about1.1 and about 1.9. Thus, according to at least some embodiments of theinstant invention, the amorphous calcium phosphate and the secondcalcium phosphate source should have a Ca/P molar ratio between about1.1 and about 1.9. In some embodiments, the Ca/P molar ratio of theamorphous calcium phosphate and the second calcium phosphate sourceranges from about 1.1 to about 1.7. Preferably, the amorphous calciumphosphate and the second calcium phosphate source when combined forms apoorly crystalline apatitic (PCA) calcium phosphate having a Ca/P molarratio of less than 1.67. Preferred poorly crystalline apatitic calciumphosphate compositions are described in, e.g., U.S. Pat. No. 6,027,742,U.S. Pat. No. 6,214,368, U.S. Pat. No. 6,287,341, U.S. Pat. No.6,331,312, and U.S. Pat. No. 6,541,037, all of which are incorporatedherein by reference.

A low temperature, high mechanical strength calcium phosphatecomposition can be used in combination with the DBM particles and,optionally, a cohesiveness agent, to prepare the implant materialaccording to the invention. Such a low temperature high mechanicalstrength calcium phosphate composition is described in e.g., U.S. Pat.No. 5,783,217, which is incorporated herein by reference.

The amorphous calcium phosphate and the second calcium phosphate sourcecan also be mixed to form a calcium phosphate powder using a high energymixing process, for example high energy milling. Such high energymilling processes are referred to as “amorphization” processes becausethey decrease the crystallinity index of the calcium phosphate sourceparticles. During amorphization, the calcium phosphate source particlesexperience multiple impacts with each other, and these impacts breakdown the particles into much smaller particles having high specificsurface areas. The impacts and corresponding transfer of energy into thecalcium phosphate source particles during amorphization may furthercause changes in their structure and/or composition. The resultingcalcium phosphate source particles are densely packed due to their smallparticle size, thereby improving the formability and cohesiveness of thebone implant materials of the invention. Further, the resulting calciumphosphate source particles react more efficiently to form hardened PCAcalcium phosphate in vivo.

In high energy ball milling, the amorphous calcium phosphate and thesecond calcium phosphate source are placed in a container and ground byrandomly moving balls agitated by rotating shafts or arms. Millingmachines like those sold under the trademarks Attritor Model 01HD,Fritch Pulverisette 4, ASI Uni-Ball Mill II, and Zoz Simoloyer® may beused. The high energy milling breaks down the amorphous calciumphosphate and the second calcium phosphate source into nanostructuralparticles on the order of less than about 100 nanometers (nm) having aspecific surface area between about 50 m²/g and about 150 m²/g. Thenanostructural particles are evenly mixed and form a high-density,homogeneous product powder, which lacks long-range crystalline order.High energy milling processes, including high energy ball milling, andtheir effects on calcium phosphate sources are further described incopending U.S. patent application Ser. No. 10/222,670, filed on Aug. 16,2002, and entitled “Synthesis of Calcium Phosphates by Mechano-ChemicalProcess.”

In at least some embodiments, the amorphous calcium phosphate and thesecond calcium phosphate source are milled for a time less than or equalto about 24 hours. In some embodiments, the amorphous calcium phosphateand the second calcium phosphate source are milled for about 15 hours.In other embodiments, the amorphous calcium phosphate and the secondcalcium phosphate source are milled for about 3 hours. As the highenergy milling time increases, the amorphization of the amorphouscalcium phosphate and the second calcium phosphate source increases andtheir X-ray diffraction pattern becomes broader and more diffuse (FIG.1).

The DBM and the calcium phosphate powder are then combined. Any mixingmethod that achieves thorough and permanent blending of the DBMparticles and the calcium phosphate powder may be employed. Such methodswill be known to those of skill in the art. For example, the DBMparticles and the calcium phosphate powder may be combined using aTurbula mixer.

The calcium phosphate powder will be present in varying amountsdepending upon the intended use and desired characteristics of theimplant material. In some embodiments, the calcium phosphate powder willbe present in an amount between about 20 and about 90 weight percent ofthe powder component. In other embodiments, the calcium phosphate powderwill be present in an amount between about 50 to about 99 weight percentof the powder component. In still other embodiments, the calciumphosphate powder will be present in an amount of about 30 weight percentof the powder component. In preferred embodiments, the calcium phosphateis present in an amount of about 85 weight percent and the DBM ispresent in an amount of about 15 weight percent.

According to some embodiments, the bone implant material additionallyincludes a biocompatible cohesiveness agent (e.g., a binder). In someinstances, the DBM content of the bone implant material is so high that,notwithstanding the formability and cohesiveness provided by the highenergy milled calcium phosphate powder, a cohesiveness agent may bedesirable to further augment the mechanical strength of the bone implantmaterial during implantation. Moreover, the inclusion of a cohesivenessagent permits the use of calcium phosphate powders other than thosepreviously discussed without significantly diminishing the mechanicalstrength of the implant material. These alternative calcium phosphatepowders need not be subjected to high energy milling processes. Thus,for example, in some embodiments, a calcium phosphate powder comprisingan amorphous calcium phosphate and an acidic second calcium phosphatesource that have not been high energy milled may be employed. Suchmaterials are described, for example, in U.S. Pat. No. 6,214,368, thecontents of which are incorporated herein by reference.

Non-limiting examples of suitable biocompatible cohesiveness agentsinclude polymers selected from polysaccharides, nucleic acids,carbohydrates, proteins, polypeptides, poly(α-hydroxy acids),poly(lactones), poly(amino acids), poly(anhydrides), poly(orthoesters),poly(anhydride-co-imides), poly(orthocarbonates), poly(α-hydroxyalkanoates), poly(dioxanones), poly(phosphoesters), poly(L-lactide)(PLLA), poly(D,L-lactide) (PDLLA), polyglycolide (PGA),poly(lactide-co-glycolide (PLGA), poly(L-lactide-co-D, L-lactide),poly(D,L-lactide-co-trimethylene carbonate), polyhydroxybutyrate (PHB),poly(ε-caprolactone), poly(δ-valerolactone), poly(γ-butyrolactone),poly(caprolactone), polyacrylic acid, polycarboxylic acid,poly(allylamine hydrochloride), poly(diallyldimethylammonium chloride),poly(ethyleneimine), polypropylene fumarate, polyvinyl alcohol,polyvinylpyrrolidone, polyethylene, polymethylmethacrylate, carbonfibers, poly(ethylene glycol), poly(ethylene oxide), poly(vinylalcohol), poly(vinylpyrrolidone), poly(ethyloxazoline), poly(ethyleneoxide)-co-poly(propylene oxide) block copolymers, poly(ethyleneterephthalate)polyamide, and copolymers thereof. Preferred cohesivenessagents also include alginic acid, arabic gum, guar gum, xantham gum,gelatin, chitin, chitosan, chitosan acetate, chitosan lactate,chondroitin sulfate, N,O-carboxymethyl chitosan, a dextran (e.g.,α-cyclodextrin, β-cyclodextrin, γ-cyclodextrin, or sodium dextransulfate), fibrin glue, glycerol, hyaluronic acid, sodium hyaluronate, acellulose (e.g., methylcellulose, carboxy methylcellulose, hydroxypropylmethylcellulose, or hydroxyethyl cellulose), a glucosamine, aproteoglycan, a starch (e.g., hydroxyethyl starch or starch soluble),lactic acid, a pluronic, sodium glycerophosphate, collagen, glycogen, akeratin, silk, and mixtures thereof. In some embodiments, thebiocompatible cohesiveness agent is water-soluble. A water-solublecohesiveness agent dissolves from the implant material shortly after itsimplantation in vivo, thereby introducing macroporosity into the boneimplant material. This macroporosity increases the osteoconductivity ofthe bone implant material by enhancing the access and, consequently, theremodeling activity of the osteoclasts and osteoblasts at the implantsite.

The biocompatible cohesiveness agent may be added to the bone implantmaterial in varying amounts and at a variety of stages during theproduction of the powder component. If included, the biocompatiblecohesiveness agent is present in an amount less than or equal to 20weight percent of the powder component (e.g., in an amount of less thanabout 1 wt %, 5 wt %, or 10 wt %, or in an amount in the range of about1 to about 20 wt %). In particular embodiments, the biocompatiblecohesiveness agent is present in an amount of about 10 weight percent ofthe powder component. In a preferred embodiment, the implant materialincludes DBM in an amount of about 50 weight percent, a calciumphosphate component in an amount of about 45 weight percent, and acohesiveness agent in an amount of about 5 weight percent. Thebiocompatible cohesiveness agent may be added to the calcium phosphatesources before or after high energy milling. The biocompatiblecohesiveness agent may be added to the DBM particles as a solution; forexample, the cohesiveness agent can coat the DBM particles. Thebiocompatible cohesiveness agent may be added to the osteoinductivepowder including the DBM particles and the calcium phosphate powder.Those of skill in the art will be able to determine the amount ofcohesiveness agent and method of inclusion required for a givenapplication.

The calcium phosphate compositions of the invention can also includebiologically active agents. In general, the only requirement is that thesubstance remain active within the paste during fabrication or becapable of being subsequently activated or re-activated, or that thebiologically active agent be added at the time of implantation of theself-hardening paste into a host or following hardening of the vehicleat 37 C in an aqueous environment.

Biologically active agents that can be incorporated into thecompositions of the invention include, without limitation, organicmolecules, inorganic materials, proteins, peptides, nucleic acids (e.g.,genes, gene fragments, gene regulatory sequences, and antisensemolecules), nucleoproteins, polysaccharides, glycoproteins, andlipoproteins. Classes of biologically active compounds that can beincorporated into the compositions of the invention include, withoutlimitation, anti-cancer agents, antibiotics, analgesics,anti-inflammatory agents, immunosuppressants, enzyme inhibitors,antihistamines, anti-convulsants, hormones, muscle relaxants,anti-spasmodics, ophthalmic agents, prostaglandins, anti-depressants,anti-psychotic substances, trophic factors, osteoinductive proteins,growth factors, and vaccines.

Anti-cancer agents include alkylating agents, platinum agents,antimetabolites, topoisomerase inhibitors, antitumor antibiotics,antimitotic agents, aromatase inhibitors, thymidylate synthaseinhibitors, DNA antagonists, farnesyltransferase inhibitors, pumpinhibitors, histone acetyltransferase inhibitors, metalloproteinaseinhibitors, ribonucleoside reductase inhibitors, TNF alphaagonists/antagonists, endothelin A receptor antagonists, retinoic acidreceptor agonists, immuno-modulators, hormonal and antihormonal agents,photodynamic agents, and tyrosine kinase inhibitors.

Any of the biologically active agents listed in Table 1 can be used.

TABLE 1 Alkylating agents cyclophosphamide lomustine busulfanprocarbazine ifosfamide altretamine melphalan estramustine phosphatehexamethylmelamine mechlorethamine thiotepa streptozocin chlorambuciltemozolomide dacarbazine semustine carmustine Platinum agents cisplatincarboplatinum oxaliplatin ZD-0473 (AnorMED) spiroplatinum, lobaplatin(Aeterna) carboxyphthalatoplatinum, satraplatin (Johnson Matthey)tetraplatin BBR-3464 (Hoffmann-La Roche) ormiplatin SM-11355 (Sumitomo)iproplatin AP-5280 (Access) Antimetabolites azacytidine tomudexgemcitabine trimetrexate capecitabine deoxycoformycin 5-fluorouracilfludarabine floxuridine pentostatin 2-chlorodeoxyadenosine raltitrexed6-mercaptopurine hydroxyurea 6-thioguanine decitabine (SuperGen)cytarabin clofarabine (Bioenvision) 2-fluorodeoxy cytidine irofulven(MGI Pharma) methotrexate DMDC (Hoffmann-La Roche) idatrexateethynylcytidine (Taiho) Topoisomerase amsacrine rubitecan (SuperGen)inhibitors epirubicin exatecan mesylate (Daiichi) etoposide quinamed(ChemGenex) teniposide or mitoxantrone gimatecan (Sigma-Tau) irinotecan(CPT-11) diflomotecan (Beaufour-Ipsen) 7-ethyl-10-hydroxy-camptothecinTAS-103 (Taiho) topotecan elsamitrucin (Spectrum) dexrazoxanet(TopoTarget) J-107088 (Merck & Co) pixantrone (Novuspharma) BNP-1350(BioNumerik) rebeccamycin analogue (Exelixis) CKD-602 (Chong Kun Dang)BBR-3576 (Novuspharma) KW-2170 (Kyowa Hakko) Antitumor dactinomycin(actinomycin D) amonafide antibiotics doxorubicin (adriamycin) azonafidedeoxyrubicin anthrapyrazole valrubicin oxantrazole daunorubicin(daunomycin) losoxantrone epirubicin bleomycin sulfate (blenoxane)therarubicin bleomycinic acid idarubicin bleomycin A rubidazonebleomycin B plicamycinp mitomycin C porfiromycin MEN-10755 (Menarini)cyanomorpholinodoxorubicin GPX-100 (Gem Pharmaceuticals) mitoxantrone(novantrone) Antimitotic paclitaxel SB 408075 (GlaxoSmithKline) agentsdocetaxel E7010 (Abbott) colchicine PG-TXL (Cell Therapeutics)vinblastine IDN 5109 (Bayer) vincristine A 105972 (Abbott) vinorelbine A204197 (Abbott) vindesine LU 223651 (BASF) dolastatin 10 (NCI) D 24851(ASTAMedica) rhizoxin (Fujisawa) ER-86526 (Eisai) mivobulin(Warner-Lambert) combretastatin A4 (BMS) cemadotin (BASF)isohomohalichondrin-B (PharmaMar) RPR 109881A (Aventis) ZD 6126(AstraZeneca) TXD 258 (Aventis) PEG-paclitaxel (Enzon) epothilone B(Novartis) AZ10992 (Asahi) T 900607 (Tularik) IDN-5109 (Indena) T 138067(Tularik) AVLB (Prescient NeuroPharma) cryptophycin 52 (Eli Lilly)azaepothilone B (BMS) vinflunine (Fabre) BNP-7787 (BioNumerik)auristatin PE (Teikoku Hormone) CA-4 prodrug (OXiGENE) BMS 247550 (BMS)dolastatin-10 (NIH) BMS 184476 (BMS) CA-4 (OXiGENE) BMS 188797 (BMS)taxoprexin (Protarga) Aromatase aminoglutethimide exemestane inhibitorsletrozole atamestane (BioMedicines) anastrazole YM-511 (Yamanouchi)formestane Thymidylate pemetrexed (Eli Lilly) nolatrexed (Eximias)synthase inhibitors ZD-9331 (BTG) CoFactor ™ (BioKeys) DNA antagoniststrabectedin (PharmaMar) mafosfamide (Baxter International) glufosfamide(Baxter International) apaziquone (Spectrum Pharmaceuticals) albumin +32P (Isotope Solutions) O6 benzyl guanine (Paligent) thymectacin(NewBiotics) edotreotide (Novartis) Farnesyltransferase arglabin(NuOncology Labs) tipifarnib (Johnson & Johnson) inhibitors lonafarnib(Schering-Plough) perillyl alcohol (DOR BioPharma) BAY-43-9006 (Bayer)Pump inhibitors CBT-1 (CBA Pharma) zosuquidar trihydrochloride (EliLilly) tariquidar (Xenova) biricodar dicitrate (Vertex) MS-209 (ScheringAG) Histone tacedinaline (Pfizer) pivaloyloxymethyl butyrate (Titan)acetyltransferase SAHA (Aton Pharma) depsipeptide (Fujisawa) inhibitorsMS-275 (Schering AG) Metalloproteinase Neovastat (Aeterna Laboratories)CMT-3 (CollaGenex) inhibitors marimastat (British Biotech) BMS-275291(Celltech) Ribonucleoside gallium maltolate (Titan) tezacitabine(Aventis) reductase inhibitors triapine (Vion) didox (Molecules forHealth) TNF alpha virulizin (Lorus Therapeutics) revimid (Celgene)agonists/antagonists CDC-394 (Celgene) Endothelin A atrasentan (Abbott)YM-598 (Yamanouchi) receptor antagonist ZD-4054 (AstraZeneca) Retinoicacid fenretinide (Johnson & Johnson) alitretinoin (Ligand) receptoragonists LGD-1550 (Ligand) Immuno- interferon dexosome therapy (Anosys)modulators oncophage (Antigenics) pentrix (Australian Cancer Technology)GMK (Progenics) ISF-154 (Tragen) adenocarcinoma vaccine (Biomira) cancervaccine (Intercall) CTP-37 (AVI BioPharma) norelin (Biostar) IRX-2(Immuno-Rx) BLP-25 (Biomira) PEP-005 (Peplin Biotech) MGV (Progenics)synchrovax vaccines (CTL Immuno) β-alethine (Dovetail) melanoma vaccine(CTL Immuno) CLL therapy (Vasogen) p21 RAS vaccine (GemVax) Hormonal andestrogens prednisone antihormonal conjugated estrogensmethylprednisolone agents ethinyl estradiol prednisolone chlortrianisenaminoglutethimide idenestrol leuprolide hydroxyprogesterone caproategoserelin medroxyprogesterone leuporelin testosterone bicalutamidetestosterone propionate; flutamide fluoxymesterone methyltestosteroneoctreotide diethystilbestrol nilutamide megestrol mitotane tamoxifenP-04 (Novogen) toremofine 2-methoxyestradiol (EntreMed) dexamethasonearzoxifene (Eli Lilly) Photodynamic talaporfin (Light Sciences)Pd-bacteriopheophorbide (Yeda) agents Theralux (Theratechnologies)lutetium texaphyrin (Pharmacyclics) motexafin gadolinium hypericin(Pharmacyclics) Tyrosine Kinase imatinib (Novartis) kahalide F(PharmaMar) Inhibitors leflunomide (Sugen/Pharmacia) CEP-701 (Cephalon)ZD1839 (AstraZeneca) CEP-751 (Cephalon) erlotinib (Oncogene Science)MLN518 (Millenium) canertinib (Pfizer) PKC412 (Novartis) squalamine(Genaera) phenoxodiol ( ) SU5416 (Pharmacia) trastuzumab (Genentech)SU6668 (Pharmacia) C225 (ImClone) ZD4190 (AstraZeneca) rhu-Mab(Genentech) ZD6474 (AstraZeneca) MDX-H210 (Medarex) vatalanib (Novartis)2C4 (Genentech) PKI166 (Novartis) MDX-447 (Medarex) GW2016(GlaxoSmithKline) ABX-EGF (Abgenix) EKB-509 (Wyeth) IMC-1C11 (ImClone)EKB-569 (Wyeth)

Antibiotics include aminoglycosides (e.g., gentamicin, tobramycin,netilmicin, streptomycin, amikacin, neomycin), bacitracin, corbapenems(e.g., imipenem/cislastatin), cephalosporins, colistin, methenamine,monobactams (e.g., aztreonam), penicillins (e.g., penicillin G,penicillin V, methicillin, natcillin, oxacillin, cloxacillin,dicloxacillin, ampicillin, amoxicillin, carbenicillin, ticarcillin,piperacillin, mezlocillin, azlocillin), polymyxin B, quinolones, andvancomycin; and bacteriostatic agents such as chloramphenicol,clindanyan, macrolides (e.g., erythromycin, azithromycin,clarithromycin), lincomyan, nitrofurantoin, sulfonamides, tetracyclines(e.g., tetracycline, doxycycline, minocycline, demeclocyline), andtrimethoprim. Also included are metronidazole, fluoroquinolones, andritampin.

Enzyme inhibitors are substances which inhibit an enzymatic reaction.Examples of enzyme inhibitors include edrophonium chloride,N-methylphysostigmine, neostigmine bromide, physostigmine sulfate,tacrine, tacrine, 1-hydroxy maleate, iodotubercidin, p-bromotetramisole,10-(alpha-diethylaminopropionyl)-phenothiazine hydrochloride,calmidazolium chloride, hemicholinium-3, 3,5-dinitrocatechol,diacylglycerol kinase inhibitor I, diacylglycerol kinase inhibitor II,3-phenylpropargylamine, N⁶-monomethyl-L-arginine acetate, carbidopa,3-hydroxybenzylhydrazine, hydralazine, clorgyline, deprenyl,hydroxylamine, iproniazid phosphate, 6-MeO-tetrahydro-9H-pyrido-indole,nialamide, pargyline, quinacrine, semicarbazide, tranylcypromine,N,N-diethylaminoethyl-2,2-diphenylvalerate hydrochloride,3-isobutyl-1-methylxanthne, papaverine, indomethacind,2-cyclooctyl-2-hydroxyethylamine hydrochloride,2,3-dichloro-a-methylbenzylamine (DCMB),8,9-dichloro-2,3,4,5-tetrahydro-1H-2-benzazepine hydrochloride,p-aminoglutethimide, p-aminoglutethimide tartrate, 3-iodotyrosine,alpha-methyltyrosine, acetazolamide, dichlorphenamide,6-hydroxy-2-benzothiazolesulfonamide, and allopurinol.

Antihistamines include pyrilamine, chlorpheniramine, andtetrahydrazoline, among others.

Anti-inflammatory agents include corticosteroids, nonsteroidalanti-inflammatory drugs (e.g., aspirin, phenylbutazone, indomethacin,sulindac, tolmetin, ibuprofen, piroxicam, and fenamates), acetaminophen,phenacetin, gold salts, chloroquine, D-Penicillamine, methotrexatecolchicine, allopurinol, probenecid, and sulfinpyrazone.

Muscle relaxants include mephenesin, methocarbomal, cyclobenzaprinehydrochloride, trihexylphenidyl hydrochloride, levodopa/carbidopa, andbiperiden.

Anti-spasmodics include atropine, scopolamine, oxyphenonium, andpapaverine.

Analgesics include aspirin, phenybutazone, idomethacin, sulindac,tolmetic, ibuprofen, piroxicam, fenamates, acetaminophen, phenacetin,morphine sulfate, codeine sulfate, meperidine, nalorphine, opioids(e.g., codeine sulfate, fentanyl citrate, hydrocodone bitartrate,loperamide, morphine sulfate, noscapine, norcodeine, normorphine,thebaine, norbinaltorphimine, buprenorphine, chlornaltrexamine,funaltrexamione, nalbuphine, nalorphine, naloxone, naloxonazine,naltrexone, and naltrindole), procaine, lidocain, tetracaine anddibucaine.

Ophthalmic agents include sodium fluorescein, rose bengal, methacholine,adrenaline, cocaine, atropine, alpha-chymotrypsin, hyaluronidase,betaxalol, pilocarpine, timolol, timolol salts, and combinationsthereof.

Prostaglandins are art recognized and are a class of naturally occurringchemically related, long-chain hydroxy fatty acids that have a varietyof biological effects.

Anti-depressants are substances capable of preventing or relievingdepression. Examples of anti-depressants include imipramine,amitriptyline, nortriptyline, protriptyline, desipramine, amoxapine,doxepin, maprotiline, tranylcypromine, phenelzine, and isocarboxazide.

Trophic factors are factors whose continued presence improves theviability or longevity of a cell. Trophic factors include, withoutlimitation, platelet-derived growth factor (PDGP), neutrophil-activatingprotein, monocyte chemoattractant protein, macrophage-inflammatoryprotein, platelet factor, platelet basic protein, and melanoma growthstimulating activity; epidermal growth factor, transforming growthfactor (alpha), fibroblast growth factor, platelet-derived endothelialcell growth factor, insulin-like growth factor, glial derived growthneurotrophic factor, ciliary neurotrophic factor, nerve growth factor,bone growth/cartilage-inducing factor (alpha and beta), bonemorphogenetic proteins, interleukins (e.g., interleukin inhibitors orinterleukin receptors, including interleukin 1 through interleukin 10),interferons (e.g., interferon alpha, beta and gamma), hematopoieticfactors, including erythropoietin, granulocyte colony stimulatingfactor, macrophage colony stimulating factor and granulocyte-macrophagecolony stimulating factor; tumor necrosis factors, transforming growthfactors (beta), including beta-1, beta-2, beta-3, inhibin, and activin;and bone morphogenetic proteins such as OP-1, BMP-2 and BMP-7.

Hormones include estrogens (e.g., estradiol, estrone, estriol,diethylstibestrol, quinestrol, chlorotrianisene, ethinyl estradiol,mestranol), anti-estrogens (e.g., clomiphene, tamoxifen), progestins(e.g., medroxyprogesterone, norethindrone, hydroxyprogesterone,norgestrel), antiprogestin (mifepristone), androgens (e.g, testosteronecypionate, fluoxymesterone, danazol, testolactone), anti-androgens(e.g., cyproterone acetate, flutamide), thyroid hormones (e.g.,triiodothyronne, thyroxine, propylthiouracil, methimazole, andiodixode), and pituitary hormones (e.g., corticotropin, sumutotropin,oxytocin, and vasopressin). Hormones are commonly employed in hormonereplacement therapy and/or for purposes of birth control. Steroidhormones, such as prednisone, are also used as immunosuppressants andanti-inflammatories.

Osteogenic Proteins

The biologically active agent is desirably selected from the family ofproteins known as the transforming growth factors-beta (TGF-β)superfamily of proteins, which includes the activins, inhibins, and bonemorphogenetic proteins (BMPs). Most preferably, the active agentincludes at least one protein selected from the subclass of proteinsknown generally as BMPs, which have been disclosed to have osteogenicactivity, and other growth and differentiation type activities. TheseBMPs include BMP proteins BMP-2, BMP-3, BMP-4, BMP-5, BMP-6 and BMP-7,disclosed for instance in U.S. Pat. Nos. 5,108,922; 5,013,649;5,116,738; 5,106,748; 5,187,076; and 5,141,905; BMP-8, disclosed in PCTpublication WO91/18098; and BMP-9, disclosed in PCT publicationWO93/00432, BMP-10, disclosed in PCT application WO94/26893; BMP-11,disclosed in PCT application WO94/26892, or BMP-12 or BMP-13, disclosedin PCT application WO 95/16035; BMP-14; BMP-15, disclosed in U.S. Pat.No. 5,635,372; or BMP-16, disclosed in U.S. Pat. No. 5,965,403. OtherTGF-β proteins which may be useful as the active agent in the calciumphosphate compositions of the invention include Vgr-2, Jones et al.,Mol. Endocrinol. 6:1961 (1992), and any of the growth anddifferentiation factors (GDFs), including those described in PCTapplications WO94/15965; WO94/15949; WO95/01801; WO95/01802; WO94/21681;WO94/15966; WO95/10539; WO96/01845; WO96/02559 and others. Also usefulin the invention may be BIP, disclosed in WO94/01557; HP00269, disclosedin JP Publication number: 7-250688; and MP52, disclosed in PCTapplication WO93/16099. The disclosures of all of the above applicationsare incorporated herein by reference. A subset of BMPs which arepresently preferred for use in the invention include BMP-2, BMP-4,BMP-5, BMP-6, BMP-7, BMP-10, BMP-12, BMP-13, BMP-14, and MP52. Theactive agent is most preferably BMP-2, the sequence of which isdisclosed in U.S. Pat. No. 5,013,649, the disclosure of which isincorporated herein by reference. Other osteogenic agents known in theart can also be used, such as teriparatide (Forteo™), Chrysalin®,prostaglandin E2, or LIM protein, among others.

The biologically active agent may be recombinantly produced, or purifiedfrom a protein composition. The active agent, if a TGF-β, such as a BMP,or other dimeric protein, may be homodimeric, or may be heterodimericwith other BMPs (e.g., a heterodimer composed of one monomer each ofBMP-2 and BMP-6) or with other members of the TGF-β superfamily, such asactivins, inhibins and TGF-β1 (e.g., a heterodimer composed of onemonomer each of a BMP and a related member of the TGF-β superfamily).Examples of such heterodimeric proteins are described for example inPublished PCT Patent Application WO 93/09229, the specification of whichis hereby incorporated herein by reference.

The biologically active agent may further include additional agents suchas the Hedgehog, Frazzled, Chordin, Noggin, Cerberus and Follistatinproteins. These families of proteins are generally described in Sasai etal., Cell 79:779-790 (1994) (Chordin); PCT Patent Publication WO94/05800(Noggin); and Fukui et al., Devel. Biol. 159:131 (1993) (Follistatin).Hedgehog proteins are described in WO96/16668; WO96/17924; andWO95/18856. The Frazzled family of proteins is a recently discoveredfamily of proteins with high homology to the extracellular bindingdomain of the receptor protein family known as Frizzled. The Frizzledfamily of genes and proteins is described in Wang et al., J. Biol. Chem.271:4468-4476 (1996). The active agent may also include other solublereceptors, such as the truncated soluble receptors disclosed in PCTpatent publication WO95/07982. From the teaching of WO95/07982, oneskilled in the art will recognize that truncated soluble receptors canbe prepared for numerous other receptor proteins. The above publicationsare hereby incorporated by reference herein. The amount of osteogenicprotein effective to stimulate increased osteogenic activity of presentor infiltrating progenitor or other cells will depend upon the size andnature of the defect being treated, as well as the carrier beingemployed. Generally, the amount of protein to be delivered is in a rangeof from about 0.1 to about 100 mg; preferably about 1 to about 100 mg;most preferably about 10 to about 80 mg.

Biologically active agents can be introduced into the calcium phosphatecompositions of the invention during or after its formation. Agents mayconveniently be mixed into the compositions prior to setting.Alternatively, the vehicle may be shaped and hardened and then exposedto the therapeutic agent in solution. This particular approach isparticularly well suited for proteins, which are known to have anaffinity for apatitic materials. A buffer solution containing thebiologically active agent may be employed, instead of water, as theaqueous solution in which the self-hardening paste is, for example,irrigated prior to implantation. Buffers may be used in any pH range,but most often will be used in the range of 5.0 to 8.0 in preferredembodiments the pH will be compatible with prolonged stability andefficacy of the desired therapeutic agent and, in most preferredembodiments, will be in the range of 5.5 to 7.4. Suitable buffersinclude, but are not limited to, carbonates, phosphates (e.g., phosphatebuffered saline), and organic buffers such as Tris, HEPES, and MOPS.Most often, the buffer will be selected for it's biocompatibility withthe host tissues and its compatibility with the therapeutic agent. Formost applications of nucleic acids, peptides or antibiotics a simplephosphate buffered saline will suffice.

Standard protocols and regimens for delivery of the above-listed agentsare known in the art. Typically, these protocols are based on oral orintravenous delivery. Biologically active agents are introduced into thevehicle in amounts that allow delivery of an appropriate dosage of theagent to the implant site. In most cases, dosages are determined usingguidelines known to practitioners and applicable to the particular agentin question. The exemplary amount of biologically active agent to beincluded in the paste of the invention or added to the hardened deliveryvehicle is likely to depend on such variables as the type and extent ofthe condition, the overall health status of the particular patient, theformulation of the active agent, and the bioresorbability of thedelivery vehicle used. Standard clinical trials may be used to optimizethe dose and dosing frequency for any particular biologically activeagent.

The invention also provides calcium phosphate compositions having aporous composition. Porosity of the calcium phosphate compositions is adesirable characteristic as it facilitates cell migration andinfiltration into the calcium phosphate compositions so that the cellscan secrete extracellular bone matrix. It also provide access forvascularization. Porosity also provide high surface area for enhancedresorption and release of active substance, as well as increasedcell-matrix interaction.

A highly porous implant can be achieved by addition of an effervescentagent to the calcium phosphate compositions. The effervescent agent maybe a gas which is dissolved in the calcium phosphate composition priorto implantation. The gas may be dissolved in the calcium phosphatecomposition under pressure, i.e., by subjecting the composite materialto a pressurized atmosphere of the gas, but which is inert to thecementing reaction. The gas is then liberated upon exposure tophysiological temperatures (i.e., upon injection or implantation), dueto the decrease in gas solubility with increased temperature. Underthese circumstances, the gas dissolution and subsequent pore formationoccurs only during hardening in vivo, and not prior to administration.This is especially attractive since pore formation is not desired tooccur at room temperature in the syringe. Suitable gases include,without limitation, carbon dioxide, air, nitrogen, helium, oxygen, andargon. Alternatively, the effervescent agent is a solid material whichliberates gas upon dissolution. For example, sodium bicarbonate evolvescarbon dioxide gas as it converts to an unstable carbonic acidintermediate, which subsequently evolves carbon dioxide and water.Desirably, the sodium carbonate is present in the calcium phosphatecompositions in an amount between 0.5 and 40% by weight. A more detaileddescription of the use of effervescent agents is found in U.S. Ser. No.10/160,607, entitled “Calcuim phosphate delivery vehicles forosteoinductive proteins,” filed May 31, 2002.

In at least some embodiments, a suitable amount of aphysiologically-acceptable fluid is added to the powder component toproduce a self-hardening paste or putty. Non-limiting examples ofsuitable physiologically-acceptable fluids include water, saline, andphosphate buffers. These paste compositions have improved flowcharacteristics compared to most previously-known bone implantmaterials, which are attributable to the inclusion of amorphous calciumphosphate and the nature of the calcium phosphate powder. Varyingamounts of fluid may be added to the powder to produce a paste havingthe desired characteristics. For example, in at least some embodiments,0.5-2.0 cc of fluid per gram of powder is used to prepare a paste thatis formable, i.e., capable of being molded and retaining its shape. Inat least some embodiments, the paste is injectable, i.e., capable ofpassing through a 16- to 18-gauge syringe.

Following the addition of the physiologically-acceptable fluid, thepaste is delivered to the implant site. The paste may be injected intothe implant site or formed into the desired shape and packed into theimplant site. The paste may be formed into the desired shape and allowedto harden before being placed into the implant site. Pre-formed devicesmay be hand shaped, molded, or machined. Those of skill in the art willrecognize implantation procedures appropriate for a given application.

The implant material demonstrates superior osteoinductivity in vivo ascompared to isolated DBM alone. For example, upon implantation, a pasteincluding (a) a powder component, including 60 weight percent DBMparticles, 30 weight percent calcium phosphate powder, and 10 weightpercent biocompatible cohesiveness agent selected from the groupconsisting of carboxymethylcellulose, polyvinylpyrrolidone, or mixturesthereof, and (b) 1 cc of a physiologically-acceptable fluid per grampowder component is more osteoinductive than DBM alone. Note that thissuperior osteoinductivity is observed despite the inclusion of theinorganic calcium phosphates, some of which have heretofore been knownin the art to inhibit the osteoinductivity of DBM. Moreover, this pasteretains its cohesiveness in vivo due to the high energy milled calciumphosphate powder and/or the inclusion of a biocompatible cohesivenessagent.

A paste of the bone implant material reacts ex vivo, i.e.,pre-implantation, or in vivo, i.e., post-implantation, to form a poorlycrystalline apatitic (PCA) calcium phosphate. The resultant PCA calciumphosphate possesses a nanometer-scale crystal structure that alsoapproximates that of natural bone. For example, the crystals of the PCAcalcium phosphate of the bone implant materials of the instant inventionare about 26 nm in length and about 8 nm in width, while those ofnatural bone are between about 23 nm to about 32 nm in length andbetween about 6 nm and about 8 nm in width. The nanometer-scale crystalstructure of the PCA calcium phosphate of the bone implant materialprovides a surface that is compatible with bone forming cells such asosteoclasts. Osteoclasts can attach and proliferate on the calciumphosphate substrate, which thereby serves as an osteoconductive materialin vivo.

The PCA calcium phosphate product has a Ca/P molar ratio similar to thatof naturally-occurring bone. The Ca/P molar ratio is between about 1.1and about 1.9. In some embodiments, the Ca/P molar ratio is between 1.2and 1.67. Preferably the Ca/P molar ratio is less than 1.67, and may beless than about 1.5. As previously discussed, the PCA calcium phosphateformation reaction proceeds substantially to completion;correspondingly, all or substantially all of the calcium and phosphatein the calcium phosphate sources of the osteoinductive powder becomepart of the PCA calcium phosphate product. Thus, the Ca/P molar ratio ofthe PCA calcium phosphate product may be controlled by the choice ofcalcium phosphate sources.

The conversion of the paste to PCA calcium phosphate occurs at ambientor body temperatures and is accompanied by hardening of the pastematerial. The hardening process is not adversely affected by theaddition of DBM or the optional biocompatible cohesiveness agent. The“self-hardening” or “self-setting” reaction occurs slowly at ambienttemperatures, i.e., between about 20° C. and 25° C., and is acceleratedsignificantly at body temperatures, i.e., between about 32° C. and about37° C. Thus, for example, the paste hardens at ambient temperaturesafter a time between about 20 minutes to about 60 minutes, while at bodytemperatures, the paste hardens after a time between about 3 minutes andabout 15 minutes. The formation and characteristics of PCA calciumphosphates are further described in U.S. Pat. Nos. 6,214,368, 6,027,742,and 5,650,176, which are incorporated herein by reference.

The hardened PCA calcium phosphate implant materials display significantcompressive strength, despite the inclusion of significant quantities ofDBM (i.e., up to about 50 wt % of the powder component). Compressivestrength is a particularly desirable attribute for certain types of boneimplants, such as spinal implants. According to some embodiments, thePCA calcium phosphate bone implant materials have a compressive strengthgreater than about 1 MPa. In particular embodiments, the compressivestrength is between 1 MPa and 20 MPa. In other particular embodiments,the compressive strength is between 2 MPa and 10 MPa.

Once the paste has converted to PCA calcium phosphate, the PCA calciumphosphate is remodeled into bone in vivo. As described above, the PCAcalcium phosphate has a chemical composition and crystalline structuresimilar to that of natural bone and is resorbable in biological systems.Remodeling involves slow degradation of the PCA calcium phosphate anduse by the body of the resulting calcium and phosphate materials togenerate new bone. Remodeling of the bone implant materials preparedaccording to one or more embodiments of the invention is a long-termprocess, usually occurring on a time scale of months to years. Boneimplant materials of higher densities require longer remodeling periodsbecause the high density and low porosity of the implants slowspenetration by cells and biological substances, causing remodeling tooccur as a long-term inward diffusion process.

According to one or more embodiments, the present invention alsoprovides a method of assaying the DBM content, by weight, in a givensample of a bone implant material. Given that the quantity of DBMaffects the properties of the bone implant materials, a method thatdetermines the quantity of DBM in a given material is desirable. The DBMcontent, by weight, in a given sample of a bone implant material may bemeasured in a DBM extraction assay. This assay utilizes hydrogenchloride (HCl) to digest the calcium phosphate sources in the boneimplant material. Upon addition of HCl, the HCl-bone implant materialmixture is agitated, centrifuged, and resuspended so as to form a pelletof extracted DBM, which may then be dried and weighed.

The invention is illustrated by the following examples, which are notintended to be limiting of the invention.

EXAMPLES Example 1 Preparation of Demineralized Bone Matrix Fibers

This Example describes the preparation of DBM particles that are fibrousin nature.

Long bones were cleaned to remove all connective tissue. The end plateswere removed to isolate the cortical bone component of the long bone,and the marrow was removed. The hollow long bones were washed in alcoholto further clean and remove fat. The bones were then turned on a lathe.Shavings were made by pressing a straight-edged silicon carbide cuttingtool into the surface of the bone. The cutting tool advances along thelength of the bone to provide a length of bone shaving. The rate ofrotation of the bone in concert with the rate of motion of the cuttingtool can be controlled by those familiar with the process so as tocontrol the rate of material removal. Shavings of thickness varyingbetween 50 μm and 250 μm, widths between 2 mm and 10 mm and randomlength were obtained by this process. These shaving were then washed inether to remove the remaining fats. Demineralization was performed bystirring the shavings in 0.5 molar hydrochloric acid (HCl) for 1 hour.After demineralization, the fibers were rinsed in deionized water untilthe excess acid was removed. The fibers were then dried by rinsing inalcohol and ether and allowing the ether to evaporate. The average fiberlength was distributed randomly between about 250 μm and 2 mm, andaverage fiber thickness was between about 50 μm and 250 μm.

Example 2 Preparation of Amorphous Calcium Phosphate

This Example describes the preparation of an amorphous calcium phosphatepowder.

A solution of 1000 g of disodium hydrogen phosphate heptahydrate(Na₂HPO₄7H₂O) in 14.4 mL distilled water was prepared and stirred. Tothis solution, 555 g sodium hydroxide (NaOH), 333 g sodium bicarbonate(NaHCO₃), and 2.2 g sodium pyrophosphate decahydrate (Na₄P₂O₇10H₂O) wereadded sequentially to form solution 1.

A solution of 208 g of calcium nitrate tetrahydrate (Ca(NO₃)₂4H₂O) in5.6 L of distilled water was prepared and stirred. 11 g of magnesiumchloride hexahydrate (MgCl₂6H₂O) was added to this solution to formsolution 2.

Solution 2 was quickly poured into solution 1 at room temperature andstirred for 1 minute. The amorphous calcium phosphate precipitatedimmediately and substantially completely. The pH of the suspension was13±0.5, which was maintained to avoid conversion of the precipitate toan apatite or other more crystalline calcium phosphate.

The precipitate was then immediately separated from its mother solutionusing a basket centrifugal filtration process and washed using about 100L of distilled water. Completion of the washing process was confirmed bythe last wash ionic conductivity less than 300 μs. This process yields agel cake of about 500 g of amorphous calcium phosphate.

The wet cake of amorphous calcium phosphate was immediately lyophilizedso as to preserve the amorphous structure during drying. About 80% ofthe water was removed. About 100 g of the lyophilized powder wascalcinated at 450° C. for 1 hour.

The amorphous calcium phosphate product had a Ca/P ratio of less than1.5, and typically between 1.35 and 1.49.

Example 3 Preparation of Dicalcium Phosphate Dihydrate (DCPD)

This Example describes the preparation of dicalcium phosphate dihydratepowder.

20 g diammonium hydrogen phosphate ((NH₄)₂HPO₄) was dissolved in 1 Ldistilled water to prepare solution 3, having a concentration of 0.300mol/L. It was verified that the pH of solution 3 was between 7.0 and9.0.

35.5 g calcium nitrate tetrahydrate (Ca(NO₃)₂4H₂O) was dissolved in 0.5L distilled water to prepare solution 4, having a concentration of 0.300mol/L. It was verified that the pH of solution 4 was between 5.0 and8.0.

Solution 4 was poured into solution 3, followed by stirring for about 2minutes. It was verified that the pH of the resulting suspension wasbetween 5.2 and 6.2. The suspension was filtered by vacuum filtration toform a uniform cake. The cake was washed three times with 750 mLdistilled water (2.25 L total). When washing was complete, the cake wasseparated from the filter paper and dried in a laminar flow hood for 24hours. The dried powder was milled through a 120 μm nominal pore sizescreen.

Example 4 Preparation of Calcium Phosphate Powder

This Example describes the preparation of a calcium phosphate powdercomprising an amorphous calcium phosphate and a second calcium phosphatesource.

Amorphous calcium phosphate, prepared as described in Example 2, andcrystalline DCPD, prepared as described in Example 3, were combined in a1:1 ratio by weight (e.g. 25 g each). The mixed powder was high energymilled in a Ball Mill at 100 RPM for about 3 hours. The averagecrystalline domain size of the resulting powder was less than about 100nm.

Example 5 Preparation of DBM/Calcium Phosphate Powder

This Example describes the preparation of a powder comprising DBMparticles and a calcium phosphate powder.

0.4 g fibrous DBM particles, prepared as described in Example 1, and 0.6g calcium phosphate powder, prepared as described in Example 4, werecombined using a Turbula mixer.

Example 6 Preparation DBM/Calcium Phosphate/Cohesiveness Agent Powder

This Example describes the preparation of a powder comprising DBMparticles, a calcium phosphate powder, and a biocompatible cohesivenessagent.

0.5 g DBM particles, prepared as described in Example 1, 0.45 g calciumphosphate powder, prepared as described in Example 4, and 0.05 gHercules 7 HFPH carboxymethylcellulose were combined in a siliconemixing bulb. The resulting powder contained about 50 wt % DBM particles,about 45 wt % calcium phosphate powder, and about 5 wt %carboxymethylcellulose.

Example 7 Preparation of Formable, Self-Hardening Paste

This Example describes the preparation of a formable, self-hardeningpaste from a DBM/calcium phosphate/cohesiveness agent powder.

1.0 g of the powder described in Example 6 was hydrated with 0.6 ccphysiological saline per gram powder to form a paste. The resultantpaste was formable, extrudable through a syringe, and hardened in lessthan 20 minutes at 37° C.

0.10 cc of the paste was extruded through a 1 cc Becton Dickinson sliptip syringe, having a cut-off tip, to form a 0.1 cc paste cylinder.

Example 8 Cohesiveness of Formable, Self-Hardening Paste

This Example describes the evaluation of the cohesiveness of a formable,self-hardening paste prepared according to the instant invention.

A 1.0 g sample of the paste prepared as described in Example 7 wasformed into a ball about 1.0 cm in diameter, and the ball was droppedinto a beaker of water. The ball retained its initial shape, withoutsignificant observable distortion, swelling, or mass loss, for at least10 minutes. The sample was removed from the water, and the water wasfiltered to determine the extent of mass lost from the sample uponimmersion. No measurable amount of mass loss was observed.

Example 9 Compressive Strength of CaP/DBM Composition

This Example describes the evaluation of the wet compressive strength ofa formable, self-hardening paste prepared according to the instantinvention.

Two grams of powder containing 0.3 g of DBM particles with a particlesize ranging from 125 to 850 μm and 1.7 g calcium phosphate powder,prepared as described in Example 4, was hydrated with 0.5 ccphysiological saline per gram powder to form a paste.

The paste was evenly loaded into 5 cylindrical stainless steel moldsmeasuring 6 mm in diameter and 12 mm in height. The molds were thenimmersed into a 37° C. physiological saline bath for 2 hours.

The five hardened CaP/DBM samples were then removed from the molds andtested for compressive strength using a universal testing machine(Instron, Canton, Mass.) at a crosshead speed of 5 mm/minutes.

The average compressive strength was measured as 12±1 MPa.

Example 10 Hardening Times of Bone Implant Materials

Table 1 presents data regarding the hardening times of various boneimplant materials prepared according to the instant invention.

TABLE 1 % DBM in Ca/P Physiologically- Setting Time Hardening TimeComposition Acceptable Fluid Temperature (min.) (min.) HCS-24¹ Saline 377 9 125-850 μm DBM (25%) HCS-24 PBS 1:30² 37 6 7 125-850 μm DBM (25%)HCS-24 Saline 35 7 9 125-850 μm DBM (25%) HCS-24 PBS 1:30 35 6 7 125-850μm DBM (25%) HCS-24 Saline 33 8 10 125-850 μm DBM (25%) HCS-24 PBS 1:3033 7 8 125-850 μm DBM (25%) HCS-24 Saline 37 6 8  50-250 μm DBM (25%)HCS-24 PBS 1:30 37 5 6  50-250 μm DBM (25%) HCS-24 Saline 35 6 8  50-250μm DBM (25%) HCS-24 PBS 1:30 35 5 6  50-250 μm DBM (25%) HCS-24 Saline33 7 9  50-250 μm DBM (25%) HCS-24 PBS 1:30 33 6 9  50-250 μm DBM (25%)HCS-24 Saline 37 8 9   <125 μm DBM (25%) HCS-24 PBS 1:30 37 6 7   <125μm DBM (25%) HCS-24 Saline 35 10 15   <125 μm DBM (25%) HCS-24 PBS 1:3035 7 10   <125 μm DBM (25%) HCS-24 Saline 33 9 10   <125 μm DBM (25%)HCS-24 PBS 1:30 33 8 9   <125 μm DBM (25%) ¹“HCS-24” refers to highcompressive strength, intimately mixed calcium phosphate sources thathave been mixed for 24 hours. ²“PBS 1:30” refers to phosphate bufferedsolutions.

Example 11 Implantation of Bone Implant Materials

Assessment of ectopic bone formation after implantation in intramuscularor subcutaneous pockets within an athymic rat is the current standardfor characterizing osteoinductive materials. This Example describes theuse of the athymic rat model to assess bone implant materials preparedas described herein and to compare those compositions to other DBMformulations.

Six to seven week old male athymic rats (Rattus norvegicus, Crl:NIH-munudes, Charles River Laboratories) were housed and maintained in anisolator or microisolator equivalent under conditions recommended in the“Guide for the Care and Use of Laboratory Animals” (National ResearchCouncil, 1996). Rats were fed gamma-irradiated rodent chow and tap waterad libitum.

Various implant compositions as described herein were tested, as shownin Table 2. The inductivity of these implant compositions was comparedto that of several implant materials known in the art: GRAFTON® DBMPutty (Osteotech, Inc.), GRAFTON® DBM Flex (Osteotech, Inc.), GRAFTON®DBM Matrix (Osteotech, Inc.), and Osteofil® (Regeneration Technologies,Inc.). All implants were implanted as a 0.1 cc cylinder having a 5 mmdiameter.

Thirty-five (35) animals were randomly implanted with four differenttest articles, two in the thoracic musculature (pectoris major muscle)and two in the hind limbs (quadriceps). Each animal received anintraperitoneal (IP) injection of ketamine (100 mg/kg) and xylazine (10mg/kg). Upon complete anesthetization, a small incision was made with ascalpel at the first implantation site, and the skin, subcutaneoustissue, and fascia were bisected with scissors. An intramuscular pouchwas formed using pointed scissors to enter the desired muscle. The firstcut was made in the same direction as the muscle fibers, and thescissors were spread to create a small pocket, which was held open while0.1 ml of the test article was administered with forceps. Once the testarticle had solidified (at least 6 minutes), the muscle pocket wassutured closed. The surgery was then repeated at the remaining threeimplant sites. If necessary an additional half dose of ketamine/xylazinewas administered to maintain anesthetization sufficient to complete theimplantation procedure.

Daily clinical observations were performed on each animal for seven dayspost-implantation. Biweekly clinical observations were performedthereafter.

The test articles were retrieved six weeks following implantation.Animals were euthanized by CO₂ overdose immediately prior to retrieval.Tissue collections were limited to the implant material andapproximately 0.5 cm margins of skeletal muscle and/or connectivetissue. Tissue specimens were fixed in 10% neutral buffered formalin fora minimum of 12 hours and transferred in histological grade alcohol.Tissue specimens were bisected transversely at the implant midsection,routinely processed for paraffin embedding, cut onto glass slides,stained with hematoxylin and eosin, and coverslipped. If necessary,tissue specimens were additionally decalcified prior to histologicanalysis.

Randomized histological slides, each representing a differentintramuscular implant section, were presented to a pathologist in ablind fashion with respect to the implant administered. The amount ofbone formation was scored using a 0-4 scale, with 0 indicating noevidence of bone formation, and 1, 2, 3, and 4 indicating <25%, 26-50%,51-75%, and >75% of implant surface involved in new bone formation,respectively. New bone lined with osteoblasts and/or containingosteocytes within lacunae and cartilaginous cells with their matrix andbone marrow surrounded with trabeculae of new bone were all regarded aspart of the bone neoformation process. The shape and size of the implant(relative to the original 5 mm cylinder), the distribution of new bonein the implant, and the nature of the implant matrix were also noted.Once the evaluation of the slides was completed, the key to groupassignment was provided to the evaluator to summarize the results, whichare provided below.

TABLE 2 Bone Induction Scores for Selected DBM - Calcium PhosphateFormulations Amount Amount Calcium Bone Inductivity Amount DBMCohesiveness Cohesiveness Phosphate Score DBM³ Type, Size (μm) AgentAgent Type Powder (0-4) 30 Particles, 125-850 15 CMC⁴ Powder 55 0.6 50Particles, 125-850 15 CMC Powder 35 0.8 40 Fibers, 250-2 mm 0 — 60 0.850 Particles, 53-125 5 CMC Powder 45 1.0 50 Particles, 125-850 5 CMCPowder 45 1.6 50 Particles, 500-850 5 CMC Powder 45 1.8 50 Particles,125-850 0 — 50 1.0 50 Particles, 125-850 5 CMC Powder 45 1.0 60 CMCCoated 0 — 40 1.0 Particles, 125-850 60 CMC Coated 10 CMC Powder 30 1.0Particles, 125-850 40 Fibers, 250-2 mm 5 CMC Powder 55 1.3 70 Particles,125-850 5 CMC Powder 25 2.0 60 Particles, 125-850 10 PVP⁵ 30 2.0 60Particles, 53-125 10 CMC Powder 30 3.0 60 Particles, 125-850 10 CMCPowder 30 2.0 GRAFTON ® DBM Putty 2.7 GRAFTON ® DBM Flex 0.8 GRAFTON ®DBM Matrix 0.5 Osteofil ® 0.8 ³Amounts of DBM, Binder, and CalciumPhosphate Powder are provided as weight percentages of the powdercomponent of the implant material. ⁴CMC denotes carboxymethylcellulose.⁵PVP denotes polyvinylpyrrolidone.

Example 12 DBM Extraction Assay

A 1.00 g sample of a DBM/calcium phosphate powder, prepared as describedin Example 5, was placed into a 50 cc centrifuge tube. Twentymilliliters of 5N HCl was added to the sample. The sample was gentlyagitated for 20 minutes to digest the calcium phosphate material. Thesample was then centrifuged for 5 minutes to form a DBM pellet, and thesupernatant carefully poured off. The DBM pellet was resuspended twicein 15 mL DI-H₂O and then once in 15 mL ethanol, centrifuging 10 minuteseach time to separate the DBM. The excess ethanol was evaporatedovernight, and the sample was dried for 24 hours in a vacuum drier. Theextracted DBM was then weighed, resulting in 0.39 g of DBM.

Other Embodiments

All publications, patents, and patent applications mentioned in thisspecification are incorporated herein by reference to the same extent asif each independent publication or patent application was specificallyand individually indicated to be incorporated by reference.

While the invention has been described in connection with specificembodiments thereof, it will be understood that it is capable of furthermodifications and this application is intended to cover any variations,uses, or adaptations of the invention following, in general, theprinciples of the invention and including such departures from thepresent disclosure that come within known or customary practice withinthe art to which the invention pertains and may be applied to theessential features hereinbefore set forth, and follows in the scope ofthe claims.

Other embodiments are within the claims.

1. An osteoinductive powder comprising: (a) demineralized bone matrix(DBM) in an amount in the range of 40 to 70 wt %, wherein said DBMcomprises particles having a particle size in the range of about 53 μmto about 850 μm, and (b) a calcium phosphate powder in an amount in therange of about 25 to about 60 wt %, wherein said osteoinductive powderforms a formable, self-hardening, poorly crystalline apatitic (PCA)calcium phosphate paste when admixed with a physiologically acceptableliquid, and wherein said paste is capable of hardening to form a PCAcalcium phosphate having a compressive strength of greater than at leastabout 1 MPa.
 2. The osteoinductive powder of claim 1, wherein said DBMcomprises about 60 wt % of said osteoinductive powder.
 3. Theosteoinductive powder of claim 2, wherein said DBM comprises about 50 wt% of said osteoinductive powder.
 4. The osteoinductive powder of claim1, wherein said DBM comprises particles having a particle size in therange of about 125 to about 850 μm.
 5. The osteoinductive powder ofclaim 1, wherein said DBM comprises particles having a particle size inthe range of about 53 to about 125 μm.
 6. The osteoinductive powder ofclaim 1, wherein said calcium phosphate powder comprises amorphouscalcium phosphate and a second calcium phosphate.
 7. The osteoinductivepowder of claim 6, wherein said second calcium phosphate is an acidic ora neutral calcium phosphate.
 8. The osteoinductive powder of claim 7,wherein said acidic calcium phosphate is calcium metaphosphate,dicalcium phosphate dihydrate, heptacalcium phosphate, tricalciumphosphate, calcium pyrophosphate dihydrate, poorly crystallinehydroxyapatite, calcium pyrophosphate, or octacalcium phosphate.
 9. Theosteoinductive powder of claim 8, wherein said acidic calcium phosphateis dicalcium phosphate dihydrate (DCPD).
 10. The osteoinductive powderof claim 6, wherein said amorphous calcium phosphate and said secondcalcium phosphate have an average crystalline domain size of less thanabout 100 nm.
 11. The osteoinductive powder of claim 1, wherein saidcalcium phosphate powder is subjected to a high energy milling processprior to admixing with said DBM particles.
 12. The osteoinductive powderof claim 1 further comprising at least one supplemental materialselected from a cohesiveness agent, a biologically active agent, and aneffervescent agent.
 13. The osteoinductive powder of claim 12, whereinsaid cohesiveness agent comprises about 0.5 to about 20 wt % of saidosteoinductive powder.
 14. The osteoinductive powder of claim 12,wherein said cohesiveness agent comprises less than about 20 wt % ofsaid osteoinductive powder.
 15. The osteoinductive powder of claim 14,wherein said cohesiveness agent comprises less than about 10 wt % ofsaid osteoinductive powder.
 16. The osteoinductive powder of claim 15,wherein said cohesiveness agent comprises less than about 5 wt % of saidosteoinductive powder.
 17. The osteoinductive powder of claim 16,wherein said cohesiveness agent comprises less than about 1 wt % of saidosteoinductive powder.
 18. The osteoinductive powder of claim 12,wherein said cohesiveness agent is a polymer selected frompolysaccharides, nucleic acids, carbohydrates, proteins, polypeptides,poly(α-hydroxy acids), poly(lactones), poly(amino acids),poly(anhydrides), poly(orthoesters), poly(anhydride-co-imides),poly(orthocarbonates), poly(α-hydroxy alkanoates), poly(dioxanones),poly(phosphoesters), poly(L-lactide) (PLLA), poly(D,L-lactide) (PDLLA),polyglycolide (PGA), poly(lactide-co-glycolide (PLGA),poly(L-lactide-co-D, L-lactide), poly(D,L-lactide-co-trimethylenecarbonate), polyhydroxybutyrate (PHB), poly(ε-caprolactone),poly(δ-valerolactone), poly(γ-butyrolactone), poly(caprolactone),polyacrylic acid, polycarboxylic acid, poly(allylamine hydrochloride),poly(diallyldimethylammonium chloride), poly(ethyleneimine),polypropylene fumarate, polyvinyl alcohol, polyvinylpyrrolidone,polyethylene, polymethylmethacrylate, carbon fibers, poly(ethyleneglycol), poly(ethylene oxide), poly(vinyl alcohol),poly(vinylpyrrolidone), poly(ethyloxazoline), poly(ethyleneoxide)-co-poly(propylene oxide) block copolymers, poly(ethyleneterephthalate)polyamide, and copolymers thereof.
 19. The osteoinductivepowder of claim 12, wherein said cohesiveness agent is selected fromalginic acid, arabic gum, guar gum, xantham gum, gelatin, chitin,chitosan, chitosan acetate, chitosan lactate, chondroitin sulfate,N,O-carboxymethyl chitosan, a dextran, fibrin glue, glycerol, hyaluronicacid, sodium hyaluronate, a cellulose, a glucosamine, a proteoglycan, astarch, lactic acid, a pluronic, sodium glycerophosphate, collagen,glycogen, a keratin, silk, and mixtures thereof.
 20. The osteoinductivepowder of claim 19, wherein said cellulose is methylcellulose, carboxymethylcellulose, hydroxypropyl methylcellulose, or hydroxyethylcellulose.
 21. The osteoinductive powder of claim 19, wherein saiddextran is α-cyclodextrin, β-cyclodextrin, γ-cyclodextrin, or sodiumdextran sulfate.
 22. The osteoinductive powder of claim 19, wherein saidstarch is hydroxyethyl starch or starch soluble.
 23. The osteoinductivepowder of claim 12, wherein said biologically active agent is selectedfrom an antibody, an antibiotic, a polynucleotide, a polypeptide, aprotein, an anti-cancer agent, a growth factor, and a vaccine.
 24. Theosteoinductive powder of claim 23, wherein said protein is an osteogenicprotein.
 25. The osteoinductive powder of claim 24, wherein saidosteogenic protein is selected from BMP-2, BMP-4, BMP-5, BMP-6, BMP-7,BMP-10, BMP-12, BMP-13, and BMP-14.
 26. The osteoinductive powder ofclaim 23, wherein said anti-cancer agent is selected from alkylatingagents, platinum agents, antimetabolites, topoisomerase inhibitors,antitumor antibiotics, antimitotic agents, aromatase inhibitors,thymidylate synthase inhibitors, DNA antagonists, farnesyltransferaseinhibitors, pump inhibitors, histone acetyltransferase inhibitors,metalloproteinase inhibitors, ribonucleoside reductase inhibitors, tumornecrosis factor (TNF) alpha agonists, tumor necrosis factor (TNF) alphaantagonists, endothelin A receptor antagonists, retinoic acid receptoragonists, immuno-modulators, hormonal agents, antihormonal agents,photodynamic agents, and tyrosine kinase inhibitors.
 27. Theosteoinductive powder of claim 12, wherein said effervescent agent issodium bicarbonate, carbon dioxide, air, nitrogen, helium, oxygen, orargon.
 28. The osteoinductive powder of claim 27, wherein saideffervescent agent comprises about 1 to about 40 wt % of saidosteoinductive powder.
 29. The osteoinductive powder of claim 1, whereinsaid paste hardens to form a PCA calcium phosphate having an overallCa/P ratio of less than about 1.67.
 30. The osteoinductive powder ofclaim 29, wherein said paste hardens to form a PCA calcium phosphatehaving an overall Ca/P ratio of less than about 1.5 when admixed withsaid physiologically acceptable liquid.
 31. The osteoinductive powder ofclaim 1, wherein said paste hardens to form a PCA calcium phosphatehaving an overall Ca/P ratio in the range of about 1.0 to about 1.67when admixed with said physiologically acceptable liquid.
 32. Anosteoinductive powder comprising: (a) demineralized bone matrix (DBM) inan amount in the range of 40 to 70 wt %, wherein said DBM comprisesparticles having a particle size in the range of about 53 μm to about850 μm; (b) a calcium phosphate powder in an amount in the range ofabout 25 to about 60 wt %; and (c) a biocompatible cohesiveness agent inan amount in the range of about 0.5 to 20 wt %; wherein saidosteoinductive powder forms a formable, self-hardening, poorlycrystalline apatitic (PCA) calcium phosphate paste when admixed with aphysiologically acceptable liquid, and wherein said paste is capable ofhardening to form a PCA calcium phosphate having a compressive strengthof greater than at least about 1 MPa.
 33. A formable, self-hardening,poorly crystalline apatitic (PCA) calcium phosphate paste suitable foruse as a bone implant material comprising: (a) a powder componentcomprising: (i) demineralized bone matrix (DBM) in an amount in therange of 40 to 70 wt %, wherein said DBM comprises particles having aparticle size in the range of about 53 μm to about 850 μm, and (ii) acalcium phosphate powder in an amount in the range of about 25 to about60 wt %; and (b) a physiologically-acceptable fluid in an amount toproduce a cohesive, formable paste, wherein said paste retains itscohesiveness when introduced at an implant site in vivo and hardens toform a PCA calcium phosphate having a compressive strength of greaterthan at least about 1 MPa.
 34. The paste of claim 33, wherein said DBMcomprises about 60 wt % of said powder component.
 35. The paste of claim34, wherein said DBM comprises about 50 wt % of said powder component.36. The paste of claim 33, wherein said DBM comprises particles having aparticle size in the range of about 125 to about 850 μm.
 37. The pasteof claim 33, wherein said DBM comprises particles having a particle sizein the range of about 53 to about 125 μm.
 38. The paste of claim 33,wherein said calcium phosphate powder comprises amorphous calciumphosphate and a second calcium phosphate.
 39. The paste of claim 38,wherein said second calcium phosphate is an acidic or a neutral calciumphosphate.
 40. The paste of claim 39, wherein said acidic calciumphosphate is calcium metaphosphate, dicalcium phosphate dihydrate,heptacalcium phosphate, tricalcium phosphate, calcium pyrophosphatedihydrate, poorly crystalline hydroxyapatite, calcium pyrophosphate, oroctacalcium phosphate.
 41. The paste of claim 40, wherein said acidiccalcium phosphate is dicalcium phosphate dihydrate (DCPD).
 42. The pasteof claim 38, wherein said amorphous calcium phosphate and said secondcalcium phosphate have an average crystalline domain size of less thanabout 100 nm.
 43. The paste of claim 33, wherein said calcium phosphatepowder is subjected to a high energy milling process prior to admixingwith said DBM particles.
 44. The paste of claim 33 further comprising atleast one supplemental material selected from a cohesiveness agent, abiologically active agent, and an effervescent agent.
 45. The paste ofclaim 44, wherein said cohesiveness agent comprises about 0.5 to about20 wt % of said powder component.
 46. The paste of claim 44, whereinsaid cohesiveness agent comprises less than about 20 wt % of said powdercomponent.
 47. The paste of claim 46, wherein said cohesiveness agentcomprises less than about 10 wt % of said powder component.
 48. Thepaste of claim 47, wherein said cohesiveness agent comprises less thanabout 5 wt % of said powder component.
 49. The paste of claim 48,wherein said cohesiveness agent comprises less than about 1 wt % of saidpowder component.
 50. The paste of claim 44, wherein said cohesivenessagent is a polymer selected from polysaccharides, nucleic acids,carbohydrates, proteins, polypeptides, poly(α-hydroxy acids),poly(lactones), poly(amino acids), poly(anhydrides), poly(orthoesters),poly(anhydride-co-imides), poly(orthocarbonates), poly(α-hydroxyalkanoates), poly(dioxanones), poly(phosphoesters), poly(L-lactide)(PLLA), poly(D,L-lactide) (PDLLA), polyglycolide (PGA),poly(lactide-co-glycolide (PLGA), poly(L-lactide-co-D, L-lactide),poly(D,L-lactide-co-trimethylene carbonate), polyhydroxybutyrate (PHB),poly(ε-caprolactone), poly(δ-valerolactone), poly(γ-butyrolactone),poly(caprolactone), polyacrylic acid, polycarboxylic acid,poly(allylamine hydrochloride), poly(diallyldimethylammonium chloride),poly(ethyleneimine), polypropylene fumarate, polyvinyl alcohol,polyvinylpyrrolidone, polyethylene, polymethylmethacrylate, carbonfibers, poly(ethylene glycol), poly(ethylene oxide), poly(vinylalcohol), poly(vinylpyrrolidone), poly(ethyloxazoline), poly(ethyleneoxide)-co-poly(propylene oxide) block copolymers, poly(ethyleneterephthalate)polyamide, and copolymers thereof.
 51. The paste of claim44, wherein said cohesiveness agent is selected from alginic acid,arabic gum, guar gum, xantham gum, gelatin, chitin, chitosan, chitosanacetate, chitosan lactate, chondroitin sulfate, N,O-carboxymethylchitosan, a dextran, fibrin glue, glycerol, hyaluronic acid, sodiumhyaluronate, a cellulose, a glucosamine, a proteoglycan, a starch,lactic acid, a pluronic, sodium glycerophosphate, collagen, glycogen, akeratin, silk, and mixtures thereof.
 52. The paste of claim 51, whereinsaid cellulose is methylcellulose, carboxy methylcellulose,hydroxypropyl methylcellulose, or hydroxyethyl cellulose.
 53. The pasteof claim 51, wherein said dextran is α-cyclodextrin, β-cyclodextrin,γ-cyclodextrin, or sodium dextran sulfate.
 54. The paste of claim 51,wherein said starch is hydroxyethyl starch or starch soluble.
 55. Thepaste of claim 46, wherein said biologically active agent is selectedfrom an antibody, an antibiotic, a polynucleotide, a polypeptide, aprotein, an anti-cancer agent, a growth factor, and a vaccine.
 56. Thepaste of claim 55 wherein said protein is an osteogenic protein.
 57. Thepaste of claim 56, wherein said osteogenic protein is selected fromBMP-2, BMP-4, BMP-5, BMP-6, BMP-7, BMP-10, BMP-12, BMP-13, and BMP-14.58. The paste of claim 55, wherein said anti-cancer agent is selectedfrom alkylating agents, platinum agents, antimetabolites, topoisomeraseinhibitors, antitumor antibiotics, antimitotic agents, aromataseinhibitors, thymidylate synthase inhibitors, DNA antagonists,farnesyltransferase inhibitors, pump inhibitors, histoneacetyltransferase inhibitors, metalloproteinase inhibitors,ribonucleoside reductase inhibitors, tumor necrosis factor (TNF) alphaagonists, tumor necrosis factor (TNF) alpha antagonists, endothelin Areceptor antagonists, retinoic acid receptor agonists,immuno-modulators, hormonal agents, antihormonal agents, photodynamicagents, and tyrosine kinase inhibitors.
 59. The paste of claim 44,wherein said effervescent agent is sodium bicarbonate, carbon dioxide,air, nitrogen, helium, oxygen, or argon.
 60. The paste of claim 59,wherein said effervescent agent comprises about 1 to about 40 wt % ofsaid powder component.
 61. The paste of claim 33, wherein said pasteself-hardens to a PCA calcium phosphate having an overall Ca/P ratio ofless than about 1.67.
 62. The paste of claim 61, wherein said pasteself-hardens to a PCA calcium phosphate having an overall Ca/P ratio ofless than about 1.5.
 63. The paste of claim 33, wherein said pasteself-hardens to a PCA calcium phosphate having an overall Ca/P ratio inthe range of about 1.0 to about 1.67.
 64. The paste of claim 33, whereinsaid paste hardens to form a PCA calcium phosphate having a compressivestrength in the range of about 1 MPa to about 20 MPa.
 65. The paste ofclaim 64, wherein said paste hardens to form a PCA calcium phosphatehaving a compressive strength in the range of about 2 MPa to about 10MPa.
 66. The paste of claim 33, wherein said paste hardens to form a PCAcalcium phosphate having a compressive strength of about 2 MPa.
 67. Aformable, self-hardening, poorly crystalline apatitic (PCA) calciumphosphate paste suitable for use as a bone implant material comprising:(a) a powder component, including: (i) demineralized bone matrix (DBM)in an amount in the range of 40 to 70 wt %, wherein said DBM comprisesparticles having a particle size in the range of about 53 μm to about850 μm, (ii) a calcium phosphate powder in an amount in the range ofabout 25 to about 60 wt %, and (iii) a biocompatible cohesiveness agentin an amount in the range of about 0.5 to 20 wt %; and (b) aphysiologically acceptable fluid in an amount to produce a cohesive,formable paste, wherein said paste retains its cohesiveness whenintroduced at an implant site in vivo and hardens to form a PCA calciumphosphate having a compressive strength of greater than at least about 1MPa.
 68. A formable, self-hardening, poorly crystalline apatitic (PCA)calcium phosphate paste suitable for use as a bone implant materialcomprising: (a) a powder component, comprising: (i) demineralized bonematrix (DBM) in an amount in the range of 40 wt % to 70 wt % of saidpowder component, wherein said DBM comprises particles having a particlesize in the range of about 53 μm to about 850 μm, and (ii) a calciumphosphate powder in an amount in the range of about 25 wt % to about 60wt % of said powder component, wherein said calcium phosphate powdercomprises an amorphous calcium phosphate and a second calcium phosphatehaving an average crystalline domain size of less than about 100 nm, and(b) a physiologically acceptable fluid in an amount to produce acoherent, formable paste, wherein said paste retains its cohesivenesswhen introduced at an implant site in vivo and hardens to form a poorlycrystalline apatitic (PCA) calcium phosphate having a compressivestrength between about 1 MPa and about 20 MPa.
 69. The paste of claim 68further comprising a biocompatible cohesiveness agent in an amount inthe range of about 0.5 wt % to about 20 wt % of said powder component.70. A bone implant material comprising a poorly crystalline apatitic(PCA) calcium phosphate, wherein said PCA calcium phosphate is formed bycombining: (a) a powder component comprising: (i) demineralized bonematrix (DBM) in an amount in the range of 40 wt % to 70 wt % of saidpowder component, wherein said DBM comprises particles having a particlesize in the range of about 53 μm to about 850 μm, (ii) a calciumphosphate powder comprising an amorphous calcium phosphate and a secondcalcium phosphate source, wherein said second calcium phosphate sourceis an acidic calcium phosphate, and (iii) a biocompatible cohesivenessagent; and (b) a physiologically-acceptable fluid, wherein said powdercomponent and said liquid combine to produce a paste that hardens toform a PCA calcium phosphate having a compressive strength between about1 MPa and about 20 MPa.
 71. A method of bone repair comprisingintroducing the bone implant material of claim 33 into a patient in needthereof at a site requiring bone repair, wherein, upon hardening, saidbone implant material has a compressive strength between about 1 MPa andabout 20 MPa.
 72. The osteoinductive powder of claim 1, wherein saidpaste is capable of hardening to form a PCA calcium phosphate having acompressive strength of between about 1 MPa and 20 MPa.
 73. Theosteoinductive powder of claim 1, wherein said paste is capable ofhardening to form a PCA calcium phosphate having a compressive strengthof between about 2 MPa and 10 MPa.
 74. The osteoinductive powder ofclaim 32, wherein said paste is capable of hardening to form a PCAcalcium phosphate having a compressive strength of between about 1 MPaand 20 MPa.
 75. The osteoinductive powder of claim 32, wherein saidpaste is capable of hardening to form a PCA calcium phosphate having acompressive strength of between about 2 MPa and 10 MPa.
 76. The paste ofclaim 33, wherein said paste hardens to form a PCA calcium phosphatehaving a compressive strength of between about 1 MPa and 20 MPa.
 77. Thepaste of claim 33, wherein said paste hardens to form a PCA calciumphosphate having a compressive strength of between about 2 MPa and 10MPa.
 78. The paste of claim 67, wherein said paste hardens to form a PCAcalcium phosphate having a compressive strength of between about 1 MPaand 20 MPa.
 79. The paste of claim 67, wherein said paste hardens toform a PCA calcium phosphate having a compressive strength of betweenabout 2 MPa and 10 MPa.
 80. The paste of claim 68, wherein said pastehardens to form a PCA calcium phosphate having a compressive strength ofbetween about 2 MPa and 10 MPa.
 81. The bone implant material of claim70, wherein said paste hardens to form a PCA calcium phosphate having acompressive strength of between about 2 MPa and 10 MPa.
 82. The methodof claim 71, wherein, upon hardening, said bone implant material has acompressive strength of between about 2 MPa and 10 MPa.
 83. Theosteoinductive powder of claim 1, wherein said DBM comprises fibers. 84.The osteoinductive powder of claim 83, wherein said DBM fibers have alength between about 50 μm and 3 mm and an aspect ratio of greater than4.
 85. The osteoinductive powder of claim 32, wherein said DBM comprisesfibers.
 86. The osteoinductive powder of claim 85, wherein said DBMfibers have a length between about 50 μm and 3 mm and an aspect ratio ofgreater than
 4. 87. The paste of claim 33, wherein said DBM comprisesfibers.
 88. The paste of claim 87, wherein said DBM fibers have a lengthbetween about 50 μm and 3 mm and an aspect ratio of greater than
 4. 89.The paste of claim 67, wherein said DBM comprises fibers.
 90. The pasteof claim 89, wherein said DBM fibers have a length between about 50 μmand 3 mm and an aspect ratio of greater than
 4. 91. The paste of claim68, wherein said DBM comprises fibers.
 92. The paste of claim 91,wherein said DBM fibers have a length between about 50 μm and 3 mm andan aspect ratio of greater than
 4. 93. The bone implant material ofclaim 70, wherein said DBM comprises fibers.
 94. The bone implantmaterial of claim 93, wherein said DBM fibers have a length betweenabout 50 μm and 3 mm and an aspect ratio of greater than 4.